Dr. Guido K. W. Frank, Director of the Developmental Brain Research Program at the University of Colorado, has proposed a biopsychosocial risk model to explain why patients develop and maintain eating disorders (Front Behav Neurosci. 2016; 10:1). Terming it “The perfect storm,” Dr. Frank proposes that the extremes of eating found in eating disorders “alter normal brain function, in particular dopamine (DA)-related pathways, and create a biological cycle that interferes with recovery.”

Dr. Frank describes a model consisting of the following elements: first, preexisting factors, including personality traits and trait alterations of neurobiology (in this model, changes in DA function) set the stage. Situational factors can occur that significantly increase or decrease food intake; this change in intake then interacts with altered DA function. Similar precipitating effects may be caused by pubertal changes. Yet another kind of precipitating factor is what Frank classifies as psychological factors: family dysfunction, poor self-esteem, and social pressures.

In Dr. Frank’s model, the final step is a self-perpetuating pattern. In AN, restriction sensitizes the DA system, leading to more restriction. In BN and BED, desensitized DA circuits drive binge eating. This model shares certain similarities with others but really highlights the potential role of dopamine function in EDs.